Application of the highway safety manual 2010 to two road sections in Western Cape

Paper presented at the 31st Annual Southern African Transport Conference 9-12 July 2012 "Getting Southern Africa to Work", CSIR International Convention Centre, Pretoria, South Africa.The Highway Safety Manual 2010 provides a new set of methodologies to evaluate or predict safety performance on road sites. It is based on crash data from the United States of America. The paper gives a brief introduction to the Highway Safety Manual 2010 and its methodologies. The applicability of these methodologies has not yet been evaluated for South African conditions. Two sections of route R44 (provincial road M 27) were analysed. Section 1 - between Klapmuts and Stellenbosch - is a single carriageway with shoulders and Section 2 - between Stellenbosch and Somerset West - is a dual carriageway road with at grade intersections. The respective safety performance functions (SPFs), modified by crash modification factors (CMF) were used to estimate the number of crashes. These were compared to the average number of crashes reported over the last 5 years, subject to the proviso that the reported crash data may not be as accurate as that of the USA. On Section 1, the single carriageway road section, the observed number of crashes was 0,67 times higher than the predicted number, but the observed number of crashes for the intersections and road segments were 0,12 and 0,95 of the predicted number respectively. The total number of crashes observed for Section 2 on the dual carriageway link sections. was about 4,7 times higher than number predicted. The number of crashes at stop controlled intersections was predicted, but as these intersections were not specified in the accident statistics, the values were added to the sections. The number of observed crashes at traffic signal controlled intersection was 1,1 times higher than the number of predicted crashes. The evidence presented in this paper indicates that the safety performance functions that were investigated cannot be transferred to the South African situation directly from the USA where they were developed. The logic of the HSM 2010 methodologies seems to be robust. The ranges of values of crash modification factors seem acceptable. This study did not attempt to explain the reasons why the predicted crash frequency differed from the actual number of crashes, as the road sections on which it was tested is not a representative sample. Local research into the shape and size of the safety performance factors and the calibration of crash modification factors should be promoted. The basis of such research is collision statistics, and every effort should be made to improve the quality of our data capturing system.This paper was transferred from the original CD ROM created for this conference. The material was published using Adobe Acrobat 10.1.0 Technology. The original CD ROM was produced by Document Transformation Technologies Postal Address: PO Box 560 Irene 0062 South Africa. Tel.: +27 12 667 2074 Fax: +27 12 667 2766 E-mail: nigel@doctech URL: http://www.doctech.co.zadm201

Managing trees in road reserves for road safety

Paper presented at the 31st Annual Southern African Transport Conference 9-12 July 2012 "Getting Southern Africa to Work", CSIR International Convention Centre, Pretoria, South Africa.Trees are planted or allowed to grow in road reserves for reasons such as aesthetics, glare screens, control of marginal access or median crossings and shade for rest areas. International research on the role of trees in road safety confirms that trees do pose a risk and positive policies to manage trees must be formulated and executed. South African provincial road authorities do not have comprehensive policies on trees. Some have policies with respect to the landscaping of road reserves, including planting of trees, at developments along the road. The road reserve must be managed to provide reasonable safety where vehicles run-off the road or hit objects on the roadway. This is in line with the philosophy of a forgiving highway. Some aspects of the management of highway trees are presented from international research. Trees must be classified with respect to factors including the distance from the road edge and possibility of falling on the road. A methodology to assess risk and manage trees is proposed. It is advised that road authorities adopt policies with respect to trees and develop strategies and procedures to manage trees to insure road safety, by maintaining clear zones (recovery areas) free of trees.This paper was transferred from the original CD ROM created for this conference. The material was published using Adobe Acrobat 10.1.0 Technology. The original CD ROM was produced by Document Transformation Technologies Postal Address: PO Box 560 Irene 0062 South Africa. Tel.: +27 12 667 2074 Fax: +27 12 667 2766 E-mail: nigel@doctech URL: http://www.doctech.co.zadm201

Trip generation and parking demand of suburban mosques in the greater Cape Town, Western Cape

Research was done to determine the trip generation and parking demand of mosques in the greater Cape Town area of the Western Cape. The research focused on mosques in suburban environments. The mosques are split into two categories: mosques that are designated to host the congregational Friday midday prayer in addition to the daily prayers and mosques that only host the daily prayers. Surveys were conducted at such mosques and relationships between the number of vehicles generated and parked at the mosques and the characteristics of the mosques and their surrounding areas were determined. A resulting trip generation rate and parking demand rate were determined for the mosques. For mosques that host the Friday midday prayer, the peak hour occurred between 12:45 and 13:45 on a Friday. The vehicle trip generation rates were found to be 1.1 per Muslim household outside of walking distance to the mosque, 0.40 per prayer space available inside the mosque, 55 trips per 100 square meters of prayer floor space inside the mosque and 0.42 trips per worshipper inside the mosque. For mosques that do not host the Friday midday prayer, the peak trip generation occurred in the Saturday evening. The vehicle trip generation rates were found to be 0.06 per prayer space available inside the mosque and 8.6 per 100 square meters of prayer floor space inside the mosque. The parking demand was found to be equal to the trip generation rates of the mosques as the typical vehicle occupation was one person and nearly all worshippers travelled by vehicle in these suburban settings. The results contribute to the understanding of the traffic characteristics of mosques, but should not be applied to other metropolitan areas without taking into consideration local travel demand and mode choice characteristics.Papers presented at the 36th Southern African Transport Conference, CSIR International Convention Centre, Pretoria, South Africa on 10-13 July 2017.Transportation research board of the national academie

Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study

Background. In high-income countries, preoperative anaemia has been associated with poor postoperative outcomes. To date, no large study has investigated this association in South Africa (SA). The demographics of SA surgical patients differ from those of surgical patients in the European and Northern American settings from which the preoperative anaemia data were derived. These associations between preoperative anaemia and postoperative outcomes are therefore not necessarily transferable to SA surgical patients.Objectives. The primary objective was to determine the association between preoperative anaemia and in-hospital mortality in SA adult non-cardiac, non-obstetric patients. The secondary objectives were to describe the association between preoperative anaemia and (i) critical care admission and (ii) length of hospital stay, and the prevalence of preoperative anaemia in adult SA surgical patients.Methods. We performed a secondary analysis of the South African Surgical Outcomes Study (SASOS), a large prospective observational study of patients undergoing inpatient non-cardiac, non-obstetric surgery at 50 hospitals across SA over a 1-week period. To determine whether preoperative anaemia is independently associated with mortality or admission to critical care following surgery, we conducted a multivariate logistic regression analysis that included all the independent predictors of mortality and admission to critical care identified in the original SASOS model.Results. The prevalence of preoperative anaemia was 1 727/3 610 (47.8%). Preoperative anaemia was independently associated with in-hospital mortality (odds ratio (OR) 1.657, 95% confidence interval (CI) 1.055 - 2.602; p=0.028) and admission to critical care (OR 1.487, 95% CI 1.081 - 2.046; p=0.015).Conclusions. Almost 50% of patients undergoing surgery at government-funded hospitals in SA had preoperative anaemia, which was independently associated with postoperative mortality and critical care admission. These numbers indicate a significant perioperative risk, with a clear need for quality improvement programmes that may improve surgical outcomes. Long waiting lists for elective surgery allow time for assessment and correction of anaemia preoperatively. With a high proportion of patients presenting for urgent or emergency surgery, perioperative clinicians in all specialties should educate themselves in the principles of patient blood management.Â

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Female chacma baboons form strong, equitable, and enduring social bonds

Analyses of the pattern of associations, social interactions, coalitions, and aggression among chacma baboons (Papio hamadryas ursinus) in the Okavango Delta of Botswana over a 16-year period indicate that adult females form close, equitable, supportive, and enduring social relationships. They show strong and stable preferences for close kin, particularly their own mothers and daughters. Females also form strong attachments to unrelated females who are close to their own age and who are likely to be paternal half-sisters. Although absolute rates of aggression among kin are as high as rates of aggression among nonkin, females are more tolerant of close relatives than they are of others with whom they have comparable amounts of contact. These findings complement previous work which indicates that the strength of social bonds enhances the fitness of females in this population and support findings about the structure and function of social bonds in other primate groups

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe